Internal Fire
by JackSparrowsBooty
Summary: Tony has pneumonia, Pepper is taking care of him. **Reposted for editing. :) Hurt/Comfort fluffiness. Rated T for mild cursing and medical jargon.
1. Chapter 1

Pepper is only mildly inexperienced with taking care of anyone and must feel like an old pro at this point, so she doesn't reflect too long on how she moves around frantically, still somewhat green to playing nurse. She doesn't know who to call—she doubts that anybody actually still at the Manhattan Stark Industries campus will know what to do for dangerously high fevers and a raging case of pneumonia because no one will be trolling the building unless they are burning the midnight oil and she knows personally that no one logs more time in the offices than her and Tony.

She'd call Rhodes because of his friendship and personal knowledge of her boss or maybe dial up Happy for his opinion on what to do, but a second glance at the illuminated clock on the lock screen of her phone changes her mind on that. Why drag either men out of bed when Tony does that enough anyway? Besides, she's pretty sure the lieutenant is across the globe at the moment, and poor faithful Happy needs his sleep.

After pacing for a few minutes in the spacious front room of Tony's New York flat, she returns to the bedroom where the man is shivering noticeably and squeezing his eyes shut. He looks so miserable she begins to feel the rising of a lump in her throat at the pure solitary dread of encountering a real issue with something as uncertain as a fever, without the proper knowledge of what to do. She can handle Tony's mild battle wounds, near-miss alcohol-poisoning induced hangovers, his three-day creative genius marathon sessions, and the around the clock demands of her job, but she is clueless when it comes to true medical emergencies. She wants somebody's advice, but the first person she'd ask is on the verge of fever-induced delirium.

She's tempted to call upon S.H.I.E.L.D. for assistance, but over a fever and a cough? She's afraid that she's making this whole ordeal into something more than it needs to be.

"Tony?" she asks softly, inching up to the side of the bed, palming his shoulder to get his attention. Touching his body is like pushing on a stone wall, the difference being the evident trembling underneath her hand. "Are you cold? Do you need another blanket?"

A burst of the chills runs through him, and his teeth chatter as he attempts to answer her. "N-no."

"Tony, you're shaking. You need to go to the hospital."

He groans and covers his face with his arms. "Ah, Potts, you know I how much I hate dealing with doctors!"

She feels relieved to hear some clarity shine through. "You'll need to bring something with when we go to the hospital."

Tony coughs worryingly, eyebrows creased in pain. He groans and presses on his right shoulder. "Ah, god dammit," he says softly.

Pepper's heart bleeds for him, but she nudges him gently to get his attention. "Come on, Tony. We need to get you to the ER."

She helps him to a sitting position, dismayed by the weakness of his limbs. He swings his feet from the bed to the ground and stands, but tilts to the side. He'd have tipped over if she hadn't have been there to catch him. "Whoa!" she cries out, gathering him into a bear hug, nearly toppling over under the solid weight of his body. "Oh, God! Tony? Can you stand? Maybe I should call an ambulance." Her slight form struggles to keep him upright, but something in him fights through the raging internal fire inside of him, and he forces himself to a standing position.

He touches her bicep. "No medics. I'll—I'll be okay, Pep. I'm just a little dizzy, 's'all." He rubs his arms and she snatches his sweatshirt from the end of his bed, helping him into the sleeves, then zips him up, and flanks him as he staggers down the hallway. On her way out, she grabs a fleece throw, tucking it underneath her arm, then has him sit onto the Italian leather couch inhabiting his lush living room while she fumbles around in the kitchen. She pulls open several drawers, cursing fitfully until she finds a washrag and wets it in his sink, and returns to him in the dark front room. He has sunk into the cushions behind him, eyes closed and she moves to his form, pressing the cloth to his burning forehead.

"Tony? Come on. We've got to go, boss."

He glances at her with a heavy-lidded expression, an exhausted flash of brown peering through a narrowed gaze. "Tired."

"I know, Tony, but we have got to take care of this. I don't know what else to do," she says, feeling tears sweep up from her throat unexpectedly.

Something must clear up the fog in his mind, because he suddenly appears completely lucid. "You okay, Pepper?" he asks before succumbing to the lung-crushing cough.

She nods, then tugs on his arm until he relents and pulls himself up with painful slowness.

* * *

After being wheeled to a room, an orderly helps her boss onto a stretcher and the nurse that had assisted them in the triage area snatches a small white cloth from a rolling cart and soaks it with water before placing it on Tony's forehead. Pepper takes a seat off to the side, opting to watch anxiously from afar. The water dribbles past his temples, through the short, dark curls, and to the back of his neck and he shudders, curling to a fetal position. The coloring in his face is a troublesome shade of white, with a purple-blue tint under his eyes and at his mouth. She's never seen him this pale in her life.

The nurse does not appear pleased with the way he is breathing and hooks up a tube to the wall, cranking a dial, attaches an oxygen mask to the end of it, then winds it around her boss's face, fitting it snugly over his airway. She cracks open one eyelid and peers into it with her penlight. "Mr. Stark? You doing okay there, sir?"

He moans in response.

"All right, sir. I know you're feeling pretty crummy, but you're going to have to talk to me."

Tony shakes visibly and grimaces as coughs erupt from his feeble chest. The nurse snaps on a pulse oximeter clip to his left index finger, watching the machine next to the bed flicker with his rapid heartbeat. Pepper strains to see the numbers and feels worry wash over her.

89. It's worse than she thought.

The nurse notices her expression, turning halfway to acknowledge her. "Sometimes breathing can become a little shallower when you lie down. It'll be all right. Even though his numbers are low, technically he's only mildly cyanotic. I know it seems a little scary, but we won't let it get out of control, I promise."

"What will happen if it does get 'out of control'?" Pepper asks, wrenching her hands together nervously.

The nurse presses a button on the wall and pages for a Dr. Cordova, then dials and quietly speaks to an individual obviously at their desk. She turns after the brief conversation ends. "If it gets worse then we'll have to sedate and intubate him, but I don't think that will be necessary."

"Then why are you calling for help?" Pepper asks sharply, hysterics building inside her chest.

"Just a precaution," the nurse says calmly, then steps out momentarily, leaving Pepper alone in the room with the genius billionaire whose body continues to be racked with intermittent chills. She's terrified to move, but he is tossing his head as his hacking persists and he grimaces in agony after the bout.

A few people in scrubs enter the room, including the nurse, and suddenly the place is full of noise, chatter, clinking of metal against metal, and the bodies act as a barrier as they surround her boss who continues to cough uncontrollably. Pepper notices that the nurse has Tony's left arm in her grip and she is tying a length of stretchy rubber around the upper bicep. She has a prepared intravenous solution hanging above her head on an IV pole and she effortlessly flicks the top of his hand for a vein, finds it, inserts a needle, then tapes the tube to his arm and connects it to the bag.

She thinks reproachfully that she should have been more careful about his fluid consumption, because she can't remember the last time he'd even bothered to drink or eat anything, but then he's fasted during a particularly manic stretch of inventive flair before, so she'd had no reason to worry beyond what is typical for his behavior.

In the same hand with the IV port, a stoic male nurse flips Tony's hand over and inserts a larger needle after determining where his artery is located. Pepper closes her eyes when he grumbles audibly, then sees his knees moving in agitation.

"All right, Mr. Stark, almost done. We just need to get an arterial blood gas reading to see how your oxygen levels are doing," the man says calmly, drawing out a vial of dark red liquid from his wrist.

"What's his temp?" the nurse from before asks another.

A moment goes by, then another female voice is heard. "104.4."

"All right, let's get him a cooling blanket and 1000 mg of ibuprofen to knock out that fever," the man in the lab coat says who is busy moving a stethoscope across the expanse of Tony's upper torso, maneuvering around the now intricate technology imbedded in the sick man's chest. The medical personnel glance at one another but say nothing about the elephant in the room. "I really don't like the way his lungs sound right now. I'd like to get a portable chest series. Ma'am?"

Pepper perks up when he directs his attention to her. "Yes?"

Dr. Cordova peers over his glasses at her. "Is it safe to perform an x-ray with this...device in his chest cavity?"

She opens and closes her mouth uncertainly, curling a copper colored strand of hair behind an ear. "I-I don't know. I think so."

"What is it, anyway?" Cordova touches the skin around it with a hard but genuinely interested expression and she suddenly decides that she understands Tony's trepidation regarding hospital emergency rooms.

She sighs. "It's miniaturized arc reactor. It's keeping fragments of shrapnel from entering his heart."

"Okay," he says uncertainly, mulling over the best action to take.

"Considering what you've seen, I expect you to practice absolute confidentiality regarding Mr. Stark's care. Nothing about his condition leaves this room, unless you want the press filling up your hospital and making your lives hell."

The doctor nods grimly.

"I think a simple upright chest series should be safe enough, but an MRI or CT is definitely out of the question. Do you know the last time he took any medication?"

"Uh, he took some Advil in the evening and a cough decongestant during the day time."

"Like Sudafed?"

"Yes, that's it."

"Okay, let's set up an IV dose of an expectorant. Keep him on 3 liters of oxygen."

Tony swipes at his nose, moving the mask from his face, but the nurses around him force it back on and he struggles, pushing devices around. Pepper watches from her seat as he fights their attempts to calm him.

"Mr. Stark, sir, you're all right. You need to keep that oxygen mask over your face," Dr. Cordova says firmly.

"Pepper," Tony calls out, eyes bright with fever and confusion. "Where are you?"

The nurses prompt her to come over and stand by his bedside while they whisper to each other about a dose of Ativan to relax him from his state of agitated delirium. She grimaces, and then pulls the cloth from the skin of his forehead puts a palm to the overheated skin, smoothing the dark hair calmingly.

"Why don't you stay here with him until he calms down a bit?"

She nods sadly. The nurse injects his IV port with a solution that she is realizes is a mild sedative, normally reserved for patients who are combative and unwilling to remain calm for medical treatment. She watches as he reverts from a deep, pained frown and tense frame to a glazed stare and relaxed muscles, which sink into oblivion as sleep takes over.

Pepper sweeps her gaze over the multitude of wires protruding from his chest, past the mild glow of the reactor, noticing that the staff had managed to disrobe him in a matter of seconds, so that he is now sporting their lovely patient attire that he hates so much. His clothes lie in a heap on the floor, his running shoes resting on the top.

A nurse comes up beside her with a blanket that is designed to bring a person's body temperature down more slowly and carefully than an abrupt dunk into a cold bath; Pepper is instructed to move out of the room or gown herself with a lead apron while they take an x-ray of his chest. A large device rolls in and she opts to take the heavy blue smock and sit at his side while they conduct their tests.

Tony doesn't budge or give any indication that he is aware of the goings-on because he is motionless during the entire process, dead to the world now that he is covered in a sheet, drugged up, oxygenated, and head tipped to the left so that she can see his peaceful facial features. The nurses maneuver his limbs this way and that for several different x-ray shots, then place his hands above his head, moving him to each side, finally returning him to his back. He only makes a tiny noise, but always remains still.

A few minutes drag by until Dr. Cordova has sufficient enough time to review the results of the blood gas, the ECG, and the x-ray films.

He sits on a rolling stool next to Pepper regarding her sympathetically. She'd been nodding off when he'd strolled back into the room. She checks her watch and realizes that it is now 5:30.

"What's going on?" she asks, rubbing her eyes wearily.

"Well, the pneumonia is definitely there, no denying that. The coughing has caused quite a bit of inflammation in his throat and the lining of his lungs, so that is making it much more difficult to take in a good, decent breath. I can only imagine what the reactor is doing to play a part in his difficulty breathing. The fever just made matters that much worse. I'm glad you brought him in."

"He won't look at it that way."

"Don't second guess yourself, Miss Potts. You did the right thing."

She swipes her face tiredly. "So what are we going to do at this point? Is he staying?"

The doctor rubs his hand over his well-manicured beard. "I'd like for his body temperature to hit below 100 degrees before he goes home. I also want to administer a breathing treatment with a medicine called Albuterol which should reduce the inflammation and help him cough out all of that in his lungs."

"Do you think he'll be all right?"

The doctor nods, patting her shoulder. "Yeah, he's going to make it through. He's strong, in good physical condition even despite the, uh, reactor in the way. Pneumonia has the potential to be deadly, but I expect a full recovery."

Pepper sighs in relief, relaxing back into the chair, her hand lightly touching Tony's crowded left arm. She is careful to avoid the IV, bandage from the arterial blood draw and the oximeter wire. Poor guy's arm will be covered in purple bruises from the needle pricks and bandages.

The mask over his face is replaced with another that is hissing and creating a mist that he is unconsciously inhaling. He only briefly swats at the mask to itch his nose, but Pepper intercepts his hand each time he tries to move it. Once the procedure is finished, they are again left to the room alone, with only momentary intrusions from the occasional nurse.


	2. Chapter 2

Pepper is sound asleep when she is jolted awake by the bustling noises of a nearby body. She startles as if struck by lightning, forgetting momentarily that she is sitting in an uncomfortable hospital chair and reacts instinctively by thrusting her arms out to brace herself. Her hands find the faux wooden supports of the seat she is semi-reclined in, and she quickly realizes that she is still in the emergency room with Tony, who is slumbering somewhat peacefully with his bed lifted to a slight incline. She watches him for a moment without thinking about the movement that had awoken her just a moment ago and she notices that the mask that had been around his airway administering albuterol is gone and in its place is a nasal cannula.

His color has not changed much at all—he remains quite pallid—and the alarming shade of bluish-purple around his mouth is still noticeable, despite the breathing treatment and administration of fever reducers to lower his spiking temperature. Although she is dismayed by his appearance, she feels relieved that he at least seems to be resting comfortably, even if that may simply be a result of the whopping dose of Ativan given to him during his delirious aggravation.

Pepper's attention falls on a nurse who comes to stop at Tony's bedside and she watches as the young woman studies the electronic gadgets monitoring his condition. For the first time since she has woken up, she reads the collection of numbers on the computer screen, narrowing her eyes to focus in on the figures. Her middle clutches at the pulse ox reading—86—a three-point drop regardless of the steroidal drug given to him a while ago.

The nurse watches the screen for a few seconds, then examines the position of the cannula and the prongs in his nostrils, fiddles with the oxygen flow, and then returns her gaze to the monitor. Pepper observes the girl with sharp-eyed intensity. The nurse does not seem to like his numbers either, and positions her stethoscope into her ears, then moves the bell-shaped listening device around his chest.

Pepper cannot see the nurse's reactions, as her back is turned toward her, so Pepper decides to interject. "What's wrong?" she asks softly.

The girl turns, pulling the tips from her ears, then wraps the stethoscope around her neck. "Oh, hello Miss Potts." Her voice is light, cheerful, but Pepper interprets this as a trained response to alleviate panic and exude calm to keep the patient and/or family members from getting flustered. She pulls an aural thermometer from an instrument table and measures his temperature with practiced ease.

Pepper ignores her attempt at remaining composed. "Are you guys certain that the breathing treatment worked? I mean, his color hasn't changed and his numbers are lower than when we got here."

The girl nods, stoic. "Yeah, I noticed that. I was just on my way to grab his doctor for advisement."

"Is it serious?" Pepper asks, a stab of fear penetrating her consciousness.

The nurse chews on her lip. "It can be if left untreated."

"What? What is _it?_" Pepper moves out of her relaxed state and sits upright, now feeling urgent barbs of fear grapple to the surface.

"My guess is a pleural effusion, which would explain the swollen lining of his lungs, the shortness of breath, and the low pulse ox. But a doctor has to officially diagnose him."

The nurse's understanding grimace is momentary, and the girl puts a reassuring palm on Pepper's shoulder as she passes to head out the door. She looks at her boss, calmly snoozing with intermittent, rumbling coughing fits disrupting what would have been complete tranquility, and gently touches his arm. His body is still overly warm, although not as bad as when she'd driven him into the ER like a woman possessed.

It takes only about half a minute of eying Tony watchfully before the nurse returns with a doctor—Dr. Cordova if she remembers correctly—and another responding nurse, who has a tag on her scrub top that indicates she is a respiratory nurse specialist. Cordova listens to the billionaire's chest similarly as the young woman had, pausing longer over his right lung and frowning in concentration, then examines the monitor readouts, seemingly oblivious to Pepper's intense scrutiny behind him.

"Rales are more prevalent to the right, but I'll need to test the percussions before we make any determination of an effusion," the doctor mumbles to the specialist.

"When was he diagnosed with pneumonia?" the older woman queries, watching Tony's numbers.

Pepper chimes in, virtually ignored. "A couple days ago."

They turn and seem surprised by her presence. The specialist nods. "That sounds about right. Has he been taking a regular dose of antibiotics?" With an affirmation from the copper-headed woman, the respiratory specialist returns her attention to Tony and pulls the neck of his gown to his navel and begins tapping her fingers in multiple locations across his chest, taking special care to avoid touching the arc reactor. "How long has he been out?"

Cordova responds quickly, pulling Tony's x-rays seemingly out of thin air and toward the overhead lights to examine them. "It's been about two hours now. He was pretty combative during the blood gas draw." The man watches her motions patiently, then hands her the images so she can inspect them herself. "I don't see any noticeable effusion, but tell me what you think."

"Was he upright during the x-ray?"

"No, he was lying down."

"Sometimes an effusion can be hard to see when the patient is in a supine or semi-inclined position. With the device in his chest, it also may be difficult to see any fluid since it acts as an obstruction."

"Maybe we should do a chest CT."

The specialist traces a finger over one of the lung images, eyes scanning the black and white picture, seeing something that Pepper cannot identify in her inexperience. "Hang on. There, the pleural space on the right side."

"You see something?"

"Yep. Lower right."

"I knew I'd need your hawk-eyes," Cordova jokes.

"Okay, looks like we're going to need to tap his chest."

Pepper feels utterly confused and rises to her feet. "What are you doing? What does tapping his chest mean?"

Cordova glances at her from over his glasses, and she realizes he does that anytime he addresses her, and she deduces the gesture as patronizing, like she is intrusive or in the way and he just wants her to leave or remain quiet. "It's technically called a thoracentesis. We draw fluid from the interstitial space between his chest cavity and his lungs to alleviate pressure and normally evaluate the sample in our lab to determine the cause. In Mr. Stark's case, we already know the cause, so the removal of the fluid build-up will help his symptoms abate, and return his oxygen saturation to normal."

The medical personnel quickly bring their attention back to Tony just as an alarm starts to sound, alerting them to a growing problem. "SATs are down to 85," the younger nurse announces.

"All right, switch to a full, low-flow mask, 10 liters," Cordova demands. "Let's get him prepped for the thoracentesis—Linda, help me roll him to his left side."

Pepper feels like she herself cannot breathe, and her muscles seem like they have seized in terror at the sight before her. Tony is moved to lie on his side, and she is grateful that she will be able to see his face even though the cannula has been replaced with a mask and his eyes remain closed in his medicated slumber.

The respiratory specialist identified as 'Linda' peers over at her from the other side of Tony's bed. "You want to come sit by him, hon'? It'll be okay, as long as you stay on his left side." Pepper nods hesitantly and pulls her chair closer to the bedside, then reaches out and gently takes her boss' lifeless right hand.

"Val, fetch me the Betadine, sterile drape, and some Lidocaine, please." Cordova positions himself next to Linda, loosening the back of Tony's hospital gown and when the young RN returns with the supplies, Pepper is glad she is unable to see the procedure. However, the doctor continues his monologue as an attempt to help her understand every step. She almost wishes he'd simply do it silently and leave it at that, keep all of the medical jargon to himself. "I'm numbing the area between the ribs where the affected lung is and then I will insert a small tube into the pleural space where the fluid buildup is. Mr. Stark should have immediate relief and this will bring his oxygen SATs up again. Val, I need a 21-gauge syringe, a 16-gauge tube, and a three-way." He is quiet as the nurse hands him the necessary items, and he performs his task. "There it is. We've got a steady flow. You were right as always, Linda."

"Output is cloudy," the woman says stoically.

"Yep, that's pretty typical for pneumonia."

"Any blood present?"

"None so far."

Pepper is busy frowning in concentration, but she is pulled from her reverie when she feels fingers tighten in her grip and she quickly glances down at Tony, who should be sleeping pretty soundly. She lets out a sad sigh when she notices that his eyelids have parted a fraction and he is grimacing, although the fathomless, dark brown eyes have that vacant, glazed quality about them indicative of being loaded to the gills and half-conscious.

"Hey, Tony," she whispers as she leans toward him. "It's okay. You'll be all right. They just need to do a procedure and then you'll feel better afterward." Pepper moves to look at Cordova and Linda. "I think he's in pain."

Linda seems unflustered. "He's probably only feeling a little bit of pinch from the syringe and tubing, and then some pressure from the fluid draw. Just in case, we'll give him a little more of a local anesthetic to ease the discomfort."

More silence fills the air and Pepper begins to rub Tony's shoulder and is relieved to see that her touch and the extra boost of the numbing agent to his back seems to have helped him relax. His eyes have fallen shut once again, but his hand maintains its firm grasp. Cordova lifts a small glass jar with fluid, and Pepper stares in morbid fascination as the doctor wiggles the container and then sets it onto a nearby tray. He presses a large gauze pad at the affected site, and after a minute releases his hand. Cordova presses his stethoscope to Tony's back on the right side, and then nods optimistically. "Sounds much better. Good breath sounds."

The doctor once again taps his fingers against the site of the fluid draw. "Oh yeah, there's the percussion I want to hear. Looks like our friendly neighborhood Ironman will be on his way toward recovery and back out to the streets to fight the bad guys in no time." He pulls the dressing away and peeks at the wound underneath, then pushes it back into Tony's skin and tapes it in place. "What are his SATs?"

Val responds quickly. "Returning to normal. They're already up to 90."

"Nice. Okay, why don't we leave the mask on him for now, but check it again in a few minutes. If his SATs are still good, reduce the oxygen flow," Cordova says and pushes his rolling stool away. "All right, that'll do it. Val, after getting another chest x-ray, make sure to monitor his vitals for the next couple of hours, and keep him on his left side. His right will be a little sore for a while. Linda, keep yourself available for any complications during that time, will you?"

"Sure thing, Doc."

"Do you want to do another portable chest, or a CT?" Val asks, pausing by the door.

"Why don't we let Mr. Stark continue to sleep. Let's bring in the portable."

"Okay."

"Thanks for your help."

As the young nurse leaves, Dr. Cordova peels off his sterile gloves and disposes of them as well as ridding himself of the syringe and tubing that he'd been using during the chest tap. "I'll see you in a couple hours," he says to Pepper, before he moves from the room.

Linda is back at Tony's side, performing her own examination of the doctor's efforts, but appears satisfied with the results. She sees Pepper's concern as she studiously watches her busywork and smiles knowingly. "He's a fighter, honey. I know it seems pretty scary, but your boss here is in good physical condition, even with that thing in his chest, and is responding well to treatment. Rest easy. It will be another two hours before we can do anything else."

"Will he need to be admitted?"

The woman shrugs her shoulder, tilting her head to the side, causing her graying hair to fall against her shoulder. "It all depends on how his lung reacts to the chest tap. If he develops a new set of symptoms or doesn't seem to improve, then we'll definitely have to keep him longer. But if he continues down the path he's on, I'd say we'll be able to send him home by 9:00 a.m."

Pepper feels a small wave of relief, but worry still tangles her insides. "What kinds of symptoms should I be watching for?"

"Any growing discomfort, pressure, lightheadedness, or any site leakage. But, we'll be monitoring his vitals, so you can go ahead and take a nap if you want. I'm sure you're pretty tired."

Pepper nods, but she once again leans toward Tony, smoothing his hair with her palm, and then rubs his arm. He does seem better, finally appearing to descend from his feverish, unsettled state and relaxing into a more peaceful, sounder sleep now that he can breathe easier. She lets out a calmed breath and lowers her back into the cushion behind her.


End file.
